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Wisdom Teeth Problem & Removal

Wisdom teeth are vestigial third molars that human ancestors used to help in grinding down plant tissue. The common postulation is that the skulls of human ancestors had larger jaws with more teeth, which were possibly used to help chew down foliage to compensate for a lack of ability to efficiently digest the cellulose that makes up a plant cell wall. As human diets changed, smaller jaws gradually evolved, yet the third molars, or "wisdom teeth", still commonly develop in human mouths. Other findings suggest that a given culture's diet is a larger factor than genetics in the development of jaw size during human development Wisdom teeth are the last teeth to erupt in the mouth. Technically they are called the 3rd molars, because they erupt behind the 2nd molars in the mouth. We have 4 wisdom teeth, two in the upper arch and two in the lower. The wisdom teeth are the ones least needed for good oral health. They may not erupt or emerge from your gums until your late teens or early twenties - if they erupt at all. Most often they are impacted or trapped in the jaw-bone and gums, usually because there is not enough room for them in your mouth. Our jaws are smaller than those of early humans, who needed large jaws and more teeth for their tougher diet.

Wisdom teeth are a frequent source of problems for many people. The biggest reason for problems is that there isn't enough room for them to erupt into the arch normally. They may also want to come in sideways. This causes them to become impacted, which means that they are impeded from normal eruption.

When they don't erupt normally, our advice is to have them removed at your earliest convenience. Some people put this off, thinking that if their wisdom teeth aren't bothering them, that they should leave them alone. The reason this is unwise is that complications from wisdom tooth surgery greatly increase the older you get. If you wait until they bother you, the extractions will be very difficult with serious risks of complications.

If, however, they can be removed in the late teens or early twenties, complications are much milder and less likely to occur. Also, when they do start to bother you, wisdom teeth can be a source of serious, even life-threatening infections that can swell to close off your breathing or can spread to your brain. Why take those chances when wisdom tooth removal at a young age is such a routine procedure? There are 4 possible ways in which wisdom teeth may cause problems

Gum disease - Most people are aware of the pain experienced during the eruption of these teeth. This generally happens because these partly erupted teeth are difficult to keep clean, and the accumulated food particles cause the gums around the tooth to get infected. Such an infection is felt as swelling and pain around the area. Sometimes the tooth is trying to erupt, but has not yet broken through the gums. When the upper tooth bites down onto this gum, pain can be caused.

Impacted - It sometimes happens that there is not enough space in the mouth for these teeth to erupt. In such cases they may try to erupt in an abnormal direction, or may get locked into the jaw. This locking is known as impaction.

Decay - A wisdom tooth may decay unnoticed, as they are the most difficult teeth to keep clean, being so far back into the mouth.

Crowding - An impacted or erupting wisdom tooth can push on adjacent teeth, causing them to become crooked or even damaging them structurally.

Cyst - If the sac that holds the crown of the wisdom tooth remains in the bone, it can fill with fluid, forming a cyst that can destroy surrounding bone.

Due to unavailability of space in the jaws, the impacted wisdom teeth grow in many different directions, commonly at an angle. The complexity of surgery depends on the type of impaction.

Angular
Partial

Horizontal
Vertical

The upper left (picture right) and upper right (picture left) wisdom tooth are distoangularly impacted. The lower left wisdom tooth is horizontally impacted. The lower right wisdom tooth is vertically impacted (unidentifiable in orthopantomogram).

Impaction

Impacted wisdom teeth fall into one of several categories. Mesioangular impaction is the most common form (44%), and means the tooth is angled forward, towards the front of the mouth. Vertical impaction (38%) occurs when the formed tooth does not erupt fully through the gum line. Distoangular impaction (6%) means the tooth is angled backward, towards the rear of the mouth. And finally, Horizontal impaction (3%) is the least common form, which occurs when the tooth is angled fully ninety degrees forward, growing into the roots of the second molar.

Typically distoangular impactions are the easiest to extract in the maxilla and most difficult to extract in the mandible, while mesioangular impactions are the most difficult to extract in the maxilla and easiest to extract in the mandible. Frequently, a fully erupted upper wisdom tooth requires bone removal if the tooth does not yield easily to forceps or elevators. Failure to remove distal or buccal bone while removing one of these teeth can cause the entire maxillary tuberosity to be fractured off and thereby the tearing out the floor of the maxillary sinus.

Impacted wisdom teeth may also be categorized on whether they are still completely encased in the jawbone. If it is completely encased in the jawbone, it is a bony impaction. If the wisdom tooth has erupted out of the jawbone but not through the gumline, it is called a soft tissue impaction. Sometimes the wisdom tooth fails to erupt completely through the gum bed and the gum at the back of the wisdom tooth extends over the biting surface, forming a soft tissue flap or lid around the tooth called an operculum. Teeth covered by an operculum can be difficult to clean with a toothbrush. Additional cleaning techniques can include using a needle-less plastic syringe to vigorously wash the tooth with moderately pressured water or to softly wash it with hydrogen peroxide.

However, debris and bacteria can easily accumulate under an operculum, which may cause pericoronitis, a common infection problem in young adults with partial impactions that is often exacerbated by occlusion with opposing third or second molars. Common symptoms include a swelling and redness of the gum around the eruption site, difficulty in opening the mouth, a bad odor or taste in the mouth, and pain in the general area which may also run down the entire lower jaw or possibly the neck. Untreated pericoronitis can progress to a much more severe infection.

If the operculum does not disappear, recommended treatment is extraction of the wisdom tooth. An alternative treatment involving removal of the operculum, called operculectomy, has been advocated. There is a high risk of permanent or temporary numbness of the tongue due to damage of the nerve with this treatment and it is no longer recommended as a standard treatment in oral surgery.

Extraction

Wisdom teeth are extracted for two general reasons: either the wisdom teeth have already become impacted, or the wisdom teeth could potentially become problematic if not extracted. Potential problems caused by the presence of properly grown-in wisdom teeth include infections caused by food particles easily trapped in the jaw area behind the wisdom teeth where regular brushing and flossing is difficult and ineffective. Such infections may be frequent, and cause considerable pain and medical danger. Other reasons wisdom teeth are removed include misalignment which rubs up against the tongue or cheek causing pain, potential crowding or malocclusion of the remaining teeth (a result of there being not enough room on the jaw/ in the mouth),as well as orthodontics.

Many dentists and most oral surgeons recommend routine extraction of third molars (wisdom teeth) supposedly to prevent future problems.



A wisdom tooth protrudes outwards from the gumline at the back of the lower teeth.




The doctor team in smile garden remove the mandibular third molar of a patient.




An extracted mandibular third molar that was horizontally impacted.




An upper and lower right wisdom tooth extracted during the same session under local anaesthetics.